The World Health Organisation since last three decades strongly encourages countries to reduce the Caesarean Section (CS) rate down to 10-15%. However, this goal nowadays appears still far from its achievement. Public decision makers are indeed struggling to design and implement effective policies to reduce the CS rate. The literature provides a wide range of factors causing a change in the CS rate, such as the patient clinical profile and the healthcare service quality provided. Maternity Pathway (MP) is considered a mean through which to standardise the cares and to reduce CSs. This study investigates the MP recently introduced in Sicilian local health authorities. Based on such an analysis, an outcome-based performance management approach has been used by the authors to build a System Dynamics model. Scenario simulation results reveal that such an approach may support decision makers to learn how to design CS reduction policies. It particularly remarks the necessity to implement policies oriented to coordinate the actions undertaken by the different actors playing a crucial role in the MP.